What is sexual performance anxiety?

The expert guide to spotting sexual performance anxiety symptoms, what to expect & what you can do about it

Have you ever felt nervous that you won’t be able to perform sexually or enjoy sex? Then you might be dealing with sexual performance anxiety. But don’t worry because you’re not alone. Between 9%-25% of men and 6%-16% of women live with sexual performance anxiety and this can stem from fears around body image or problems between partners.

If this resonates with you, we’re here to help with our expert guide to sexual anxiety symptoms and what you can do to help alleviate them.

What is sexual performance anxiety?

“Sexual anxiety refers to feelings of unease, worry or fear related to sexual activities or situations,” explains Dr Naomi Sutton, consultant physician and spokesperson for the Family Planning Association. This worry can take over and make it difficult to perform or enjoy sex.

“Most of us have had these feelings at some point – intimacy skills have to be learnt, and part of learning is making mistakes, which can feel embarrassing in the moment but they allow for healthy growth,” Dr Naomi continues.

If you’re relating to these feelings and wondering when you should seek help, Dr Naomi advises that, “Sexual anxiety becomes problematic if it becomes a persistent feeling that leads to disruption in the enjoyment of sexual activities, avoidance of sexual situations or sexual dysfunctions – such as lack of desire and arousal, erection problems, anorgasmia (delayed, infrequent or absent orgasms), vaginal dryness or pain.”

Remember, sexual health is an important part of our general health and wellbeing, so if you’re concerned about anxiety or feel it’s affecting your day-to-day life, consider seeing a GP.

What are the causes of sexual performance anxiety?

Sexual performance anxiety is an umbrella term for a number of different worries that could affect sexual performance. Some of these are specific to men but there are more general sexual performance-related issues that could also affect women.

“The most common root of sexual anxiety is born out of unrealistic expectations and pressure to be ‘perfect’,” explains Dr Naomi. “We are bombarded with films, pornography and forms of social media where people often pick up ideas about what sex ‘should be like’ – and that just isn’t reality.”

A common cause of sexual performance anxiety in women is worrying about not being able, or taking too long, to achieve orgasm. Erectile dysfunction can be a symptom of sexual performance anxiety that affects men and describes the difficulty of getting and maintaining an erection hard enough or long enough for sexual activity. Premature ejaculation, which is when men reach sexual climax too early, could also lead to performance anxiety in men.

Everyday stress

Most people are pretty familiar with everyday stress, but did you know it can have a big impact on sexual performance? You might not link work-related stress, family issues or financial problems to your sex life but the worry they cause can affect our ability to focus on and enjoy sex.

Other causes

Some symptoms of sexual anxiety can be specific to men or women, such as whether a man can get an erection, but there are also some issues that are common to everyone.

• Low confidence or self-esteem
• Body image issues
• Previous negative sexual experiences
• Fear of rejection
• Fear of an underwhelming sexual performance
• Concern over the ability to satisfy a partner

What are some of the sexual anxiety symptoms to look out for?

Unfortunately, one of the most negative effects of sexual performance anxiety is that mental health issues can end up becoming physical health symptoms. “Put simply: persistent sexual anxiety can lead to sexual dysfunction, which is when someone might present to me in clinic," explains Dr Naomi.

Ultimately, worrying about sex, among other things, can affect our ability to become sexually aroused, enjoy sex or reach orgasm.

One example of how mental symptoms of sexual performance anxiety can become physical in men is how stress hormones cause blood vessels to narrow. This can affect blood flow to the penis, making it more difficult to get an erection. Men who are sexually attracted to their partner and haven’t had any difficulty becoming aroused in the past can still struggle to become erect. And even when able to get an erection, they might find it difficult to orgasm.

Sexual performance anxiety can affect women’s ability to become aroused, too. Not being able to fully focus on sex can result in a woman not being lubricated enough for sexual activity. This can lead to sex feeling physically uncomfortable.

What makes sexual performance anxiety such a vicious circle is that a few bad or disappointing sexual experiences can put a person off wanting to have sex for a while – or even altogether. This could impact their confidence, the relationship with their partner and future sexual experiences.

How to overcome sexual performance anxiety

Wondering how to overcome sexual anxiety and ease the cycle of negative thoughts? The good news is, with treatment, sexual performance anxiety can be overcome and lead to a thriving sex life.

And if one treatment doesn’t work, there are multiple options to try.

To try before sex

Communicate with your partner

Talking about any issues that are bothering you could improve things. Whether this is talking to your partner or speaking to a therapist, communication is key. You might even find that confiding in your partner allows them to support and reassure you. 

This may also be a good opportunity for both parties to think of solutions to overcome any nerves, such as discussing what you feel comfortable with, or perhaps thinking about how to overcome performance anxiety sexually by coming up with different or creative approaches to sex that you’ll both enjoy.

“Communicate with your partner,” urges Dr Tihesia Riley, junior doctor and creator of sexual and reproductive health awareness organisation @_SheTalks_.

“Have open discussions about likes, dislikes, what helps or hinders your anxiety, what you find affirming or dysphoric for your gender identity during sex. It’s also completely fine to let your partner know that you’re feeling a bit anxious before sex.”

Psychological therapy

One of the most effective treatment options for general anxiety and depression, psychological therapy can also be used to help overcome sexual performance anxiety. Therapy allows patients to talk about any worries with a medical professional who can listen to concerns and help resolve the underlying issues. They can also help with understanding and adapting feelings about our bodies and sex. As well as being somebody to talk to, a therapist can help with finding solutions, such as helping to manage anxiety and providing guidance on changing behaviour patterns that may cause or contribute to symptoms.

Boots Depression and Anxiety Treatment Service* offers consultations with a medical professional, plus access to tailored treatment and support for both in and outside of the bedroom.

Therapy for couples to address intimacy issues is also available via Blueheart Online Relationship & Sex Therapy at Boots. This is a great option to explore for partners who want to manage their issues together. Sex therapy may be available on the NHS in some areas, too, so speaking to a GP about a possible referral is another option.

Supporting a partner with sexual performance anxiety:

Speaking of working through things as a couple: “Supporting a partner with sexual performance anxiety may look different depending on what is contributing to it,” explains Dr Tihesia. Some things we can do include:

● “Encourage them to talk about it. When communicating, try to be open-minded and understanding. Make sure you respond in a non-critical and non-judgemental way. You want to create a safe environment for them. 

● “Try not to see it as a reflection on you. It’s easy, and very common, to see a partner’s anxiety as a fault of your own, though this is often not the case! Repeatedly switching the focus onto you, without fully discussing the topic as above, may worsen their anxiety.

● “Be patient and give them time to work through things. Try not to put too much pressure on them, take things slowly and be prepared to stop, pause or postpone sex if your partner wishes to.”

Indulge in some self-care

“If body image contributes to your performance anxiety, there are techniques that can improve it – it can be really debilitating,” admits Dr Tihesia. “Some techniques to try include challenging negative thoughts, practising body appreciation and being mindful of social media use.

“If everyday stress is creeping into your sex life and causing performance anxiety, it may help to try to be as relaxed as possible – sometimes easier said than done. Things such as a massage, hot bath or shower before sex could help. In the long term, techniques including meditation, exercising or mindfulness can also help to reduce stress.”

Is there such a thing as sexual self care? Sure there is. “Reflect on your relationship with pornography,” advises Dr Tihesa. “While pornography can be a healthy part of partnered or solo sex, it can also set unrealistic expectations on yourself and others. Remember that porn rarely reflects real-life sexual encounters.”

And last but not least, it’s worth getting to know yourself better, too. “Masturbation, or solo sex, is a great way to identify your own likes and dislikes and feel a bit more in tune with your body,” Dr Tihesia adds.

Medication

If you’re having problems getting and maintaining an erection (erectile dysfunction), there are a range of different treatments available. You can begin by speaking to a GP to discuss any symptoms and check that the erectile dysfunction is not the result of an underlying issue. You can also visit a pharmacist for help.

You can also visit the Boots Online Doctor Erectile Dysfunction Service* where, after answering a few questions to assess suitability for treatment, you’ll be offered access to a range of oral erectile dysfunction medicines. This means that you won’t need to have a face-to-face consultation and, if treatment is suitable, pick up your ED treatment in store or have it delivered with no postage fees.

There are also several treatment options that can help with premature ejaculation. These include medication that comes in the form of prescription tablets, anaesthetic creams and topical ED gels for men.

For women who find they might not be lubricated enough for sex due to their anxiety, lubricants such as gels and jelly can be used to help make sex more comfortable.

Exercise

Whether it’s taking up strength training to help you feel good or pelvic floor exercises to gain control of your pelvic floor muscles, exercise is a great way to help overcome a range of different causes of sexual performance anxiety and boost your confidence. When we exercise, our bodies release hormones called endorphins, which increase feelings of happiness and positivity. As well as helping to improve our general health, exercise can also help lower stress levels and improve mental wellbeing.

You might find these a little different from the types of exercise you’re used to doing at the gym, but pelvic floor exercises (known as kegels) are an effective way of strengthening the muscles that are key to sexual performance. Pelvic floor exercises are useful for everyone, as they can reduce symptoms of erectile dysfunction in men and help women to experience stronger orgasms.

If you’re unsure where your pelvic muscles are and how they feel, a good tip is to try to stop the flow of urine when you next go to the toilet. This is a good way to discover and test these muscles if you’re new to this. But try not to do it too often, as stopping the flow while in the middle of urinating can harm your bladder.

Now that you know how to flex your pelvic muscles, you can strengthen them by sitting comfortably and engaging (squeezing) them up to 10-15 times in a row. When you feel you’ve got used to engaging your muscles, try holding for a few seconds to really improve the pelvic floor’s strength and then fully relax the muscles down again (this is equally important). You can add more repetitions each week but be careful not to overdo it and remember to rest between each set. You should start to notice results after a few months but make sure to carry on with the exercise regularly to continue to benefit from it.

To do during sex

Reframe your view of sex

“Try to be ‘in the moment’ – this is known as mindfulness,” Dr Tihesia advises. “It can decrease anxiety in general, but it can also be used during sex to help you feel more present. It’s a way of allowing your mind to be aware of all the different sensations that your body is experiencing. You might want to try this out during solo-sex first – practice makes perfect!”

Use the ‘brakes & accelerators’ model

“How we function in sexual situations can help people to work out what might be going on in their nuanced situation, so they can identify what needs to be worked on,” Dr Naomi explains.

“If I suspect something is related to sexual anxiety, I will often talk to them about the Dual Control Model – also known as the ‘brakes and accelerators’ model,” she begins. “We all have ‘sexual accelerators’, which are factors or stimuli that promote sexual arousal and desire. Examples of accelerators may be erotic images or physical touch.”

Now for the flip side: “‘Sexual brakes’ refer to the factors or stimuli that inhibit or suppress sexual arousal and desire. Brakes act as a counterbalance to the accelerators and can prevent or decrease sexual responsiveness. These can be psychological, emotional or environmental factors that create inhibitions or reduce sexual interest. Examples might include stress, anxiety, fatigue, relationship conflicts, negative body image, distraction, past traumas or cultural and religious beliefs.

“It can be helpful for individuals to consider what their particular accelerators are so they can, in effect, push down on the gas pedal and increase the revs! This would involve thinking about a situation in which they enjoyed sex and considering what factors made it enjoyable. Was it a type of touch or activity, was it very romantic, did they feel very safe, was it kinky? Finding out what it is that really excites their erotic mind can help focus what they might need to communicate to their partner or partners.

“This is just as important when concentrating on what the brakes might be that are affecting sexual situations. We want to reduce the breaking so we can get back on the road again in the future. In situations involving sexual dysfunction due to performance pressure or pain, I will very often suggest a sex ban for several weeks but encourage other forms of intimacy, such as touch and massage, to increase intimacy and communication without the pressure of penetration.

“With some couples a common ‘brake’ can be lack of novelty, so this method can often result in couples rediscovering what they both need and desire – if communication remains open and honest. Masturbation is incredibly healthy and often very important so that we know exactly how we like to be touched and how our bodies respond. This can be very helpful if someone is struggling with a pain condition, as getting back in touch with their own bodies on their own can feel much safer than with a partner.”

To do after sex

Aftercare

“This is the term used for what happens after sex, to help your overall wellbeing,” Dr Tihesia tells us. “It looks different for different people and will depend on what you need to feel safe and comfortable. Part of this could include something to help you relax and reduce sexual performance anxiety – such as a soothing hot drink, cuddling with your partner or talking.”

Be kind to yourself

While the above tips are all effective ways of helping to overcome sexual performance anxiety, it’s important to set realistic expectations for yourself. “We need to be kind to ourselves and be aware that our brains are the biggest erogenous zone, not our genitals,” says Dr Naomi.

“We can be intimate and sexy even if the genitals are not quite working as we may want them to at certain times. Let’s take the pressure off performance and put more emphasis on pleasure –  whatever that might look like for us.”

And remember, no one else has the same body as you or experiences sex in exactly the same way, so being kind to yourself is perhaps the best start to overcoming any anxiety.